I have been reading through your excellent website and found it very informative. I have a mild form of gynaecomastia, where the biggest problem for me is the puffiness of the nipple, however I also find the area of my areolar to be problematic also. I am due to undergo surgery on this very soon, and my surgeon has given me guidance on the matter, but also has encouraged me to perform my own research. It seems to me that there are two ways of addressing my case. Either:

An incision along the lower border of the areolar, ranging from a 9 to 3 oclock position. This would address the problem of nipple puffiness.

or

An incision completely ringing the nipple, enabling a donut shaped piece of skin to be removed. This would enable the area of the nipple to be reduced aswell.

Am I correct in my summarisation?

It is deciding between these approaches that is causing me so much difficulty. The diameter of my areolar is roughly 34mm and my surgeon has informed me that whilst this is above average, it is not excessively large. I must balance this against the tendency for a donut incision to scar worse than the half circle incision. In your experience of both approaches, do you find the full circumferential incision to have undesirable and noticeable scarring? I am also a little unsure of how removing a section of skin serves to reduce the size of the areolar, as surely reducing the amount of skin would increase the tension forces stretching the areolar outwards?

I would very much appreciate any information you could give me that would aid me in my decision.

For years have been documenting this issue by measuring the nipple areola complex before and after surgery. I take measurements of the

long axis

short axis

angle the axis varies from the horizonatal

height projection

I perform this measurement with calipers.

I see an areola shrinkage with surgery. Just how much the areola shrinks, I think is technique dependent. By targeting gland first in every case where there is a gland contour component, the differences can be really radical. The tissues of the nipple areola complex can attach to the gland just at the anatomic nipple or more commonly through a diffuse attachment to the edge of the areola and beyond. When this gland attachment remains behind, the nipple areola can be forced to the larger remaining gland size. The remaining gland can also be one of the causes of the term I coined Residual Puffy Nipple Deformity, where the shape of the areola maintains the gland shape and size.

The changes I was seeing were so dramatic, that I started using the calipers on the patients' chest in front of a mirror to show the differences. This became a component of my program for the emotional healing component for each patient who permits me to take off the dressing in my office or who returns for a long term followup.

Large Gland Removed through tiny 1.6cm incision.

Puffy Nipples Before Surgery

Calipers Set to Before Surgery Dimensions

Calipers Set to Before Surgery Dimensions

Notice the radical change in size and shape of areola. In some dimensions we have been recording a 70 percent decrease in size of some of the dimensions. There is also a concentration of pigment color. The same number of color cells in a smaller results in a darker areola.

Also notice the size of my incision. It is based on how small I can make an incision and still get my small finger into to wound to feel for the firmer gland. An incision extending half way around the areola just is not needed for my typical sculpture unless I am revising the scar of someone who did the surgery before.